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Biomedical subjects

J V Hamerlynck

Publications and source records attributed to J V Hamerlynck.

At least 19 recordsLinked to original sources
PubMed2003

[Vaginal contraception: new form of administration of hormonal contraception].

The vaginal contraceptive ring works systemically by releasing 120 micrograms etonogestrel (a third generation progestogen) and 15 micrograms ethinylestradiol per day. As little independent research has been done on the efficacy and effectiveness of the vaginal contraceptive ring, it seems too early for the uncompromising propagation of systemic vaginal contraception. Women who occasionally omit to take the pill and those reluctant to use an intra-uterine device may possibly benefit from this form of contraception.

Administration, Intravaginal↗
PubMed2001

[Health Council of Netherlands recommendation 'Serum screening for risk assessment of Down syndrome for all women' poorly supported].

The Health Council of the Netherlands has recommended a new policy of offering triple test-based serum screening for Down's syndrome to all pregnant women rather than the current policy of maternal age-based screening for pregnant women aged 36 years and above. In these older pregnant women, this risk-assessment serum screening would indeed prevent many miscarriages caused by the invasive procedure. However, in pregnant women under 30 years of age this policy would imply the need to counsel almost 80,000 young pregnant women each year, and the need to perform 2,200 invasive procedures in order to detect 29 Down's syndrome cases, while 45 cases would still remain undetected. Moreover, as only 11% of the detectable Down's syndrome cases are found in women under 30, it would appear advisable to only offer the risk-assessment serum screening to pregnant women aged 30 years and above.

Adult↗
PubMed2001

[Modern intra-uterine contraception: a better option].

Users of oral contraceptives have an increased risk of developing venous thromboembolism as well as mammary cancer. This raises the question as to whether locally applied (intrauterine) contraceptives can offer a valuable alternative with respect to efficiency and safety. During the past decade the use of modern intrauterine devices (IUDs) has made substantial progress in comparison with the use of IUDs during the 1970s and 1980s. Modern IUDs have become more efficient than oral contraception. Arguments against the use of IUDs (problems and complications in IUD insertion, the risk of pelvic inflammatory disease, ectopic pregnancy and infertility as well as side effects such as menorrhagia, pelvic cramps and IUD expulsion) generally appear to be based on a lack of awareness with respect to recent developments and on misunderstandings derived from bad experiences during the 1980s and earlier.

Contraception↗
PubMed1999

Clinical outcome after unilateral oophorectomy in patients with polycystic ovary syndrome.

The objective of this study is to report retrospectively on the clinical outcome of unilateral oophorectomy in 14 women with polycystic ovary syndrome who had undergone this treatment 14-18 years ago in our hospital for clomiphene citrate-resistant anovulation and long standing infertility or for severe hirsutism. The main outcome measures were menstrual cycle, pregnancy, hirsutism, testosterone concentrations, and premature ovarian failure. Unilateral oophorectomy restored regular menstrual cycles in 12 of the 14 patients. Thirteen years later, nine out of 12 patients still had regular menstrual cycles. Ten patients wished to become pregnant. Seven of them conceived spontaneously. Eleven patients complained of severe hirsutism. After unilateral oophorectomy, hirsutism regressed subjectively in six. Testosterone blood concentrations decreased significantly within the first year after unilateral oophorectomy in 11 patients. None of the women entered menopause within 14-18 years after surgery. Our results indicate that unilateral oophorectomy restores ovulatory function for many years in the majority of patients and does not result in premature ovarian failure. However, unilateral oophorectomy should not be recommended as a standard treatment for clomiphene citrate-resistant patients with polycystic ovary syndrome.

Adult↗
PubMed1998

[The family practitioner and the postcoital test].

There is still a great deal of controversy on the value of the postcoital test. Some consider it to be a valuable method for the general practitioner to evaluate the interaction in vivo between spermatozoa and cervical mucus, in spite of the poor predictive value of the test. The postcoital test is in fact only an indirect method for the detection of the production of moving sperms. As a negative postcoital test is frequently due to bad timing of the test, multiple mandatory intercourse is often necessary, which may lead to frustration and sexual dysfunction. Moreover, there are no indications that the postcoital test with its poor discriminatory power may be better in general practice than the fertility evaluations by a specialist as standardisation and reproducibility problems are equal in both settings. Therefore semen analysis appears to be a better option, for the general practitioner as well.

Family Practice↗
PubMed1998

[Last word on hormone replacement and breast cancer?].

A very large meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer has revealed an increasing risk of breast cancer with longer durations of use of hormonal replacement therapy (HRT). This risk increase is restricted to current users of HRT or women who ceased use recently. A 35% increase of the relative risk of breast cancer was found after 5 years of HRT use or longer. After cessation of HRT use the excess breast cancer risk disappeared in 5 years, even after long durations of use. The risk increase was greater for women of normal or lean body weight than for more obese women. Tumours found in women who ever used HRT were diagnosed at a lower clinical stage, which suggests that enhanced screening might be involved. However, the increased breast cancer mortality in HRT users, as found in other studies, rather suggests a biologic mechanism Long-term use of HRT is not yet common in the Netherlands, but an increasing trend is present. Thus, the benefits of long-term use of HRT must be carefully weighted against the risks.

Aged↗
PubMed1997

Unilateral oophorectomy in polycystic ovary syndrome: a treatment option in highly selected cases?

We performed unilateral oophorectomy (UO) in three patients with polycystic ovary syndrome (PCOS) and long-standing infertility. The indication for performing this procedure was a combination of ovarian pathology and the long-standing infertility. All three patients were resistant to clomiphene citrate and before UO all patients had been treated unsuccessfully with gonadotrophins and in-vitro fertilization. All three patients became ovulatory within the first month after UO. Two patients conceived 11 and 12 months after surgery respectively and delivered healthy babies. Testosterone concentrations decreased in two patients to upper values of the normal range and remained unchanged in one patient. We conclude that restoration of ovulation can be a beneficial side-effect of UO in clomiphene citrate resistant patients with PCOS and long-standing infertility.

Adult↗
PubMed1995

Suspected ectopic pregnancy. What to do when human chorionic gonadotropin levels are below the discriminatory zone.

OBJECTIVE: To assess the value of a noninvasive diagnostic strategy in cases of suspected ectopic pregnancy when transvaginal sonography (TVS) and serum human chorionic gonadotropin (hCG) measurement show inconclusive findings. STUDY DESIGN: Prospective study of 85 patients without pregnancy detectable on initial TVS together with low hCG levels (< 1,500 IU/L). The diagnostic strategy combined the results of TVS, hCG measurements and time, according to a strict algorithm. RESULTS: Overall test results of the strategy were excellent: sensitivity, 0.94; specificity, 1.00; likelihood ratio of a positive test result, infinity; likelihood ratio of a negative test result, 0.06. The strategy revealed a new diagnostic entity, trophoblast in regression (TIR). TIR represents patients with declining hCG levels and unknown locations of their pregnancies, presenting a benign clinical picture, and constituted 54% of the population studied. CONCLUSION: This noninvasive diagnostic strategy proved to be very reliable. Because the strategy integrated expectant management of patients with declining hCG levels, it prevented many unnecessary surgical procedures. This was of great benefit for both patients with early intrauterine pregnancies and those with TIR.

Algorithms↗
PubMed1993

Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?

Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the diagnostic value of an algorithm, combining transvaginal sonography with an HCG cut-off level between 1000 and 1500 IU/l (IRP) was tested in 208 consecutive women at risk for ectopic pregnancy. Three diagnostic categories are designated by the algorithm: intra-uterine pregnancy (n = 73), ectopic pregnancy (n = 89), and trophoblast in regression (n = 46). The latter category represents patients in whom no pregnancy could be located by transvaginal sonography, with an initial HCG concentration < 1500 IU/l, declining during follow-up. The algorithm has a sensitivity of 0.97, a specificity of 0.95, a likelihood ratio for a positive test of 19.4, and a likelihood ratio for a negative test of 0.03. The described diagnostic strategy thus proved extremely reliable in the safe management of patients at risk for ectopic pregnancy, and renders laparoscopy obsolete.

Algorithms↗
PubMed1993

Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach.

In this prospective study among 208 high-risk patients with suspected ectopic pregnancy, the diagnostic value of transvaginal sonography and serum human chorionic gonadotrophin (HCG) measurements were analysed in detail. The absence of an intra-uterine gestational sac obviously was the most constant sonographic finding among patients with ectopic pregnancy (n = 89), with a very high sensitivity (0.99) but a low specificity (0.41). The application of different HCG cut-off levels improved specificity to 1.00 for values exceeding 4500 IU/l. Clinical utility obviously decreased, as many patients presented with HCG values well below this level. The additional effect of adnexal findings was analysed. Sonographic identification of an ectopic pregnancy was very specific (0.99) but had low sensitivity (0.56) because many ectopics were not detected. The additional effect of HCG values on these results was minor. The low HCG cut-off levels advocated in recent studies are questioned by the results of our analysis: whereas the combined use of sonography and HCG measurements is shown to be of great benefit, the limitations are also documented, underlining the need for re-evaluation at intervals of patients with low HCG values. The question of which cut-off level should be used in practice, however, hinges on a difficult choice between a certain specificity and clinical utility.

Adnexa Uteri↗
PubMed1990

[Norplant].

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Adult↗